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At least 487 records · Page 27Linked to original sources
PubMed2003

[Advanced rectal cancer: attitudes of French surgeons].

PURPOSE: French guidelines recommended the treatment of locally advanced rectal cancers. Our aim was first to describe therapeutic decision of digestive surgeons related to clinical cases and then to measure their knowledge of french guidelines. METHODS: Two vignettes were mailed to 183 french surgeons, randomly selected. The first one dealt with a man, 46-years-old, with a rectal cancer T3N0M0. The second one dealt with a woman, 50-years-old, with a rectal cancer complicated by a rectovaginal fistula. Questions covered the decision modality and the therapeutic choice. RESULTS: We received back 124 responses (67%). The decision modality was multidisciplinary for half of the surgeons. For the former case, the therapeutic choice fits with guidelines--radiotherapy followed by conservative surgery--for 69% of surgeons. For the latter case, more than half of the surgeons chose an association of radiotherapy-surgery-chemotherapy. Age appeared to be a limiting factor for a curative surgery. Surgeons therapeutics attitudes meet with changes in practice already observed in 1990, but 1/3 of surgeons still did not follow the guidelines. Chemotherapy was chosen while its efficacy has not been demonstrated. CONCLUSION: There is few overlapping between attitudes, and optimal surgical practices. Quality of surgery, in the art of debate, may improve thanks to the rulemaking of therapeutic decisions and thanks to the evolution of the state-of-the-art among multidisciplinary committees or professional networks.

Age Factors↗
PubMed1999

Public reporting of surgical mortality: a survey of New York State cardiothoracic surgeons.

BACKGROUND: Public disclosure of individual surgeons mortality following coronary artery bypass (CAB) is part of the New York State Department of Health Cardiac Surgery Reporting System (CSRS). The effects on the practice of cardiac surgery, as perceived by surgeons, remain unknown. METHODS: All 150 New York State cardiac surgeons were sent an anonymous mail survey in 1997. Data was analyzed to determine the dominant opinion regarding the CSRS. RESULTS: One hundred and four surgeons (69.3%) responded. The majority (70%) did not experience a change in practice. Data reporting was performed by the surgeon or an employee (58%). Many picked the incorrect definition of chronic obstructive pulmonary disease (COPD) (45%) or statistical method (60%). The aspect of CSRS most in need of improvement was gaming with risk factors (40%). Most surgeons (62%) refused to operate on at least one high-risk CAB patient over the prior year, primarily because of public reporting. Refusal was more common in surgeons in practice less than 10 years, those with less than 100 cases per year, and those with a mixed cardiothoracic practice (p < 0.05, Pearson's chi2 test). A significantly higher percentage of high-risk CAB patients were treated non-operatively, when compared with ascending aortic dissection patients (not disclosed) (p < 0.001, Wilcoxon signed ranks test). CONCLUSIONS: The public disclosure of surgical results may be based on imperfect data and appears to have resulted in denial of surgical treatment to high-risk patients.

Adult↗
PubMed1998

The surgeon's use of ultrasound in the acute setting.

As the role of the general surgeon continues to evolve, the surgeon's use of ultrasound will surely influence practice patterns, particularly for the evaluation of patients in the acute setting. With the use of real-time imaging, the surgeon receives "instantaneous" information to augment the physical examination, narrow the differential diagnosis, or initiate an intervention. With select ultrasound examinations, the surgeon can rapidly evaluate adult and pediatric patients who present with an acute abdomen, especially those in shock. In the hands of the surgeon, this noninvasive bedside tool can more accurately assess the presence, depth, and extent of an abscess, confirm complete aspiration, or diagnose wound dehiscence before it is apparent on physical examination. Ultrasound is so accurate for the diagnosis of pyloric stenosis that it has essentially replaced the upper gastrointestinal series in most institutions. The surgeon's use of ultrasound to detect a pleural effusion has virtually replaced the lateral decubitus film. Furthermore, an ultrasound-guided thoracentesis not only facilitates the procedure but improves its safety. Many ICUs now have protocols in place to perform routine duplex surveillance of those patients who are considered at high risk for the development of thromboembolic complications. As surgeons become more facile with ultrasound, it is anticipated that other uses will develop to further enhance its value for the assessment of patients in the acute setting.

Abdomen↗
PubMed2002

One versus two proficient laparoscopic surgeons for laparoscopic live donor nephrectomy.

OBJECTIVES: To compare the laparoscopic donor nephrectomy (LDN) results obtained by two different surgical teams, one consisting of a proficient laparoscopic surgeon assisted by an inexperienced laparoscopic surgeon and another consisting of two proficient laparoscopic surgeons. With more centers embarking on LDN programs, it is important to identify the factors that can improve overall outcomes during the initial learning curve. METHODS: A retrospective review was performed of the initial 70 sequential LDNs performed between October 1998 and March 2001 at our institutions. The procedures were stratified into two groups. Group 1 consisted of LDN cases performed by one proficient laparoscopic surgeon and an inexperienced laparoscopic surgeon (resident, fellow, or faculty) as the first assistant; group 2 consisted of cases performed by two proficient laparoscopic surgeons. RESULTS: Twenty-six LDNs were performed by group 1 and 44 by group 2. The total operative time and estimated blood loss showed a statistically significant decrease in group 2 compared with group 1, 143 +/- 32 minutes versus 218 +/- 38 minutes (P <0.001) and 92 +/- 115 mL versus 158 +/- 148 mL (P = 0.044), respectively. Two major complications occurred in group 1 (7.7%) and two major complications occurred in group 2 (4.5%). The 3-month postoperative recipient creatinine levels were similar for both groups, 1.6 +/- 1.3 versus 1.4 +/- 0.4 (P = 0.408). CONCLUSIONS: A surgical team composed of two proficient laparoscopic surgeons during the early learning curve of LDN may allow safe and efficient development of a laparoscopic live donor renal transplantation program.

Clinical Competence↗
PubMed2002

[Distribution of pulmonologists and chest surgeons in Spain].

OBJECTIVE: To study the real situation of respiratory medicine specialists and chest surgeons in the Spanish health service. SUBJECTS AND METHOD: Using the database of the secretary of the Spanish Society of Respiratory Medicine and Chest Surgery (SEPAR) for 1999, we gathered data on 326 Spanish hospitals. We were thus able to ascertain the level of staffing of respiratory medicine and chest surgery departments. The results were expressed as simple percentages showing distribution by age, duties and geographic area. The number of specialists per 100,000 inhabitants in each community was also calculated based on population data provided by the National Statistics Institute for 1997. RESULTS: We studied 1,786 physicians or surgeons (1,245 pneumologists, 185 surgeons and 356 from other specialties). The mean age was 41 9 years for pneumologists, 44 10 years for surgeons and 51 8 years for the others. We observed unequal distribution by geographic area, with a high of 6.66 pneumologists and 0.9 surgeons per 100,000 inhabitants in Asturias and Madrid, respectively and a low of 1.4 pneumologists per 100,000 inhabitants in Murcia and 0 surgeons in Extremadura. CONCLUSIONS: Specialist coverage by pneumologists and chest surgeons is inadequate in many provinces and communities in Spain. The professional market is not saturated, indicating that future specialists can look forward to market demand.

Adult↗
PubMed2003

Positive margins after laparoscopic radical prostatectomy: a prospective study of 100 cases performed by 4 different surgeons.

OBJECTIVE: Laparoscopic radical prostatectomy (LRP) has been refined by experienced surgeons into a competitive treatment alternative for localized prostate cancer. Less is known, however, about the outcomes of "learning curve" cases from newly trained surgeons. We prospectively studied 100 cases of LRP performed by 2 senior and 2 junior surgeons and addressed the rates of positive margins-an important early endpoint of oncologic efficacy. METHODS: 100 consecutive cases of LRP were performed by two senior (n=62) and two junior surgeons (n=38) by a 5-port transperitoneal route. Whole-mount step-section prostate specimens were examined by Stanford protocol. RESULTS: Positive margins occured in 25% of cases: 18% for pT2a (2/11), 18% for pT2b (11/61), 45% for pT3a (10/22), and 50% for pT3b (2/4) (p=0.002 pT2 vs. pT3). By surgeon experience, the rates were 19% (12/62) for senior and 34% (13/38) for junior (p=0.04). However, in a multiple logistic regression analysis, only pathologic stage (p=0.083) and Gleason sum (p=0.0133) reached statistical significance, while surgeon experience did not (p=0.0992). CONCLUSION: Positive margin rates after laparoscopic radical prostatectomy are significantly influenced by pathologic stage and Gleason score, and are within the range reported from open series. The higher positive margin rate from junior surgeons, although not statistically significant, suggests the need for further study and continued mentoring during surgery and/or video review of cases to improve oncologic results.

General Surgery↗
PubMed1996

Surgical results: a justification of the surgeon selection process for the ACAS trial. The ACAS Investigators.

PURPOSE: The selection of surgeons to participate in a prospective randomized trial comparing the efficacy of a surgical method with medical management is critically important because it will have a direct impact on the outcome of the study and the future use of the operation. We report the success of the method used for selecting surgeons who participated in the Asymptomatic Carotid Atherosclerosis Study (ACAS) by examining the surgical morbidity and mortality rates and the outcome of the study. METHODS: A Surgical Management Committee established criteria for auditing surgeons who wished to participate in the study. The parameters included a minimum performance of at least 12 carotid endarterectomies (CEA) per year and an audit of each surgeon's last 50 consecutive CEAs with required documentation of a combined neurologic morbidity and mortality rate of <3.0% for asymptomatic patients and <5.0% for all indications including symptomatic patients. RESULTS: As of February 1991, 164 surgeons from 48 medical centers applied for ACAS participation. One hundred seventeen were approved, and their aggregate experience of 5641 operations yielded a combined neurologic morbidity and mortality rate of 2.3% for asymptomatic and symptomatic patients combined. The morbidity and mortality rate for CEA on asymptomatic patients was 1.7%. These surgeons, plus those recruited after February 1991, became investigators in the ACAS trial and were responsible for the surgical care of 825 patients who were randomized to the surgical arm. Seven hundred twenty-four patients actually underwent CEA. One patient (0.14%) died and ten patients (1.38%) had strokes within the 30-day perioperative interval, for a combined stroke or death incidence of 1.52%. The 5-year stroke event rate in the surgical group (including perioperative morbidity and mortality rates) was 5.1%. compared with 11% of patients treated medically, yielding a relative risk reduction of 53% in favor of surgery (p=0.004). CONCLUSIONS: A method for selecting surgeons for participation in the ACAS trial was successful in providing low perioperative morbidity and mortality rates. This materially influenced the outcome of the study in favor of CEA.

Arteriosclerosis↗
PubMed2002

Surgeon experience and patient comfort during clear corneal phacoemulsification under topical local anesthesia.

PURPOSE: To evaluate patient comfort during topical anesthesia clear corneal phacoemulsification surgery performed by a surgeon in the learning curve or by an experienced surgeon. SETTING: Royal Alexandra Hospital, Paisley, Scotland, United Kingdom. METHODS: This study comprised 46 consecutive patients having phacoemulsification under topical anesthesia of proparacaine 0.5% (Proxymetacaine. Surgery was performed by a surgeon during his learning curve (n = 20) or by an experienced surgeon (n = 26). No sedation or intracameral anesthesia was used in either group. All patients had clear corneal phacoemulsification with foldable acrylic posterior chamber intraocular lens implantation. Each patient's subjective experience of overall pain perioperatively (period immediately surrounding and during surgery) and worst pain perceived during surgery was measured immediately after surgery using a 10-point visual analog scale. RESULTS: There was no significant difference in patient-reported pain scores for overall pain perioperatively (P =.47, Wilcoxon rank sum test) and the worst pain perceived during surgery (P =.32, Wilcoxon rank sum test). CONCLUSIONS: Topical anesthesia with proparacaine provided similar and reasonable analgesic effects in patients having surgery by a surgeon in the learning curve and those having surgery by an experienced surgeon. The discomfort perceived during surgery performed by an experienced surgeon was less, although not statistically significantly different.

Aged↗
PubMed2001

Surgeons and injury prevention: what you don't know can hurt you!

BACKGROUND: The most effective treatment for traumatic injuries is to prevent them from occurring. Currently, few surgeons receive any formal training in injury' control and prevention. This study was designed to test the knowledge of injury prevention principles among practicing surgeons, in order to identify areas in need of intensified educational efforts. STUDY DESIGN: Survey questions designed by members of the American College of Surgeons Committee on Trauma were programmed into a specialized touch-screen computer, which was displayed at four different surgery and trauma meetings, including the ACS Clinical Congress in 1999 and 2000. Participants were questioned about their knowledge of trauma epidemiology, bicycle helmet effectiveness, child safety seat usage, suicide, and domestic violence. RESULTS: Seventy-nine surveys were completed by surgeons, including 33 specializing in trauma care, and by 106 nurses attending trauma courses. Overall, the percentage of correct answers was 50%. There were no significant differences in survey scores between trauma surgeons and general surgeons, although both scored higher than trauma nurses. Areas where knowledge deficits were the most apparent included proper use of child safety seats, the effectiveness of airbags, the prevalence of suicide, and the annual cost of injury in America. CONCLUSIONS: The majority of practicing surgeons and nurses, including those working at trauma centers, are unaware of the basic concepts of injury prevention. Advancements in the field of injury control will require efforts to educate medical professionals and the public.

Accident Prevention↗
PubMed2003

An assessment of surgeons' abilites to site colostomies accurately.

AIMS: The ability of surgeons to site a colostomy is assessed in a clinical model. In addition, the tuition received by surgical trainees in stoma siting is also reviewed. MATERIALS AND METHODS: Eleven surgeons (trainees--six, colorectal subspeciality interest--two) were asked to site an end colostomy on nine patients using an adhesive disc (diameter--1cm). The position of the stoma was then measured on the 'x' and 'y' axis of a 2cm box grid, (maximum error--1cm) which was placed on the abdomen and centred on the umbilicus. The positions were then compared with that chosen by the stoma nurse who was taken as the gold standard. Results were compared using ANOVA and the Mann Whitney--U test. A telephone questionnaire was then undertaken to review the training of junior surgeons. RESULTS: There was variance present within the group of surgeons studied (p<0.01). Trainees and consultants had a similar accuracy in stoma-siting (p<0.2). Consultants with a colorectal subspeciality interest were better at placing stomas than those with a general interest (p<0.002). Badly placed stomas were three times more likely to be too low than too high (p<0.002). Thirty of 37 trainees reported receiving no undergraduate training from a specialist stoma nurse. Ninety per cent received postgraduate training from another surgeon while a specialist nurse trained only 35%. CONCLUSION: There was no difference between trainees and consultants in their ability to site a colostomy. However, surgeons with a subspeciality interest chose stoma sites that were more consistent with the specialist nurse than general surgeons. Training is haphazard and ability is frequently assumed rather than proven.

Clinical Competence↗
PubMed2005

500 years of the College of Surgeons and 300 years of the Chair of Anatomy in Edinburgh.

2005 represents the 500th anniversary of the award of the first Charter to the Guild of Surgeons and Barbers at Edinburgh, and the 300th anniversary of the establishment of the Chair of Anatomy in the University of Edinburgh, the first Chair in this discipline in Britain. The first Charter of the Incorporation, in 1505, specified that they should dissect the body of one dead condemned criminal each year. Candidates who wished to join the Incorporation were required to be familiar with all of the gross structures of the human body. In Cambridge and Oxford, those pursuing the medical courses in these Universities during the 16th and 17th centuries were expected to have both seen and undertaken a number of anatomical dissections during their undergraduate careers. Difficulties were often encountered, however, in obtaining adequate numbers of bodies for this purpose. In Edinburgh, from 1505, for more than a century, surgical apprentices were instructed in Human Anatomy. As a result of the efforts of certain surgeons during the 17th century, Pharmacy was also taught in addition to Surgery and Anatomy. During the mid-17th century, difficulties were encountered because the earlier examiners had not entered into the Incorporation's Minutes how their examinations should be undertaken. A new Act was prepared that described in detail how these should be conducted, and this emphasised the importance of a detailed knowledge of Anatomy. In 1694, Alexander Monteith, probably on the initiative of Archibald Pitcairne, requested unclaimed bodies from the Town Council to undertake dissections. Later in 1694, the Incorporation made a similar request to the Town Council, and both requests were granted. It is believed that for political reasons Monteith probably did not pursue his claim further. The Council stipulated that the Surgeons should build an Anatomical Theatre by the end of 1697 where public dissections could be carried out. This was achieved, and these were carried out in 1702 and 1704. On 1 February 1705, the Surgeons appointed Robert Elliot as their "public dissector of anatomie." He had volunteered to undertake all of the annual public dissections in Edinburgh, and the Members of the Incorporation of Surgeons unanimously accepted his offer. On 29 August 1705, at the request of the Surgeons, the Edinburgh Town Council appointed him their first Professor of Anatomy, and instructed the University's Treasurers to pay him 15 pounds Sterling per annum as his salary. As a result of the activities of the Incorporation of Surgeons and the Town Council, the first Chair of Anatomy was established in Britain, in the University of Edinburgh.

Anatomy↗
PubMed2002

Julian Smith: scientific surgeon, photographer, inventor.

Julian Augustus Romaine Smith was one of the surgeons who, in the company of Thomas Dunhill, Hugh Devine, Douglas Shields and David Murray Morton, established Saint Vincent's Hospital, Melbourne, as arguably the premier surgical hospital in Victoria, if not Australia. Smith abandoned a most promising scientific career to study medicine, completing his medical course in Melbourne where he graduated top of his year in 1898/1899. He gained his MD in 1901 and set up practice in Morwell, a Victorian country town, where he initiated his surgical career. In 1905 Smith returned to Melbourne and worked as assistant to Mr F. D. Bird, a prominent surgeon. He travelled overseas in 1906, visiting leading medical centres in England where Almroth Wright's work on vaccination made a deep impression on him. On his return to Australia in 1908 he joined the surgical staff at Saint Vincent's Hospital as surgeon to outpatients, finally retiring as surgeon to inpatients in 1928. Smith was made a Foundation Fellow of the Australasian College of Surgeons in 1927. Smith was regarded by his peers as a brilliant innovative surgeon with a special interest in urology. He became an expert cystoscopist. After he retired, he continued his long-standing interest in portrait photography for which he was considered a master. During World War II he designed and built an elegant roller pump for use in direct blood transfusion. He died in 1947, survived by his wife, a daughter and three sons, one of whom became President of the Royal Australasian College of Surgeons.

England↗
PubMed2003

Preoperative cardiac assessment for patients with infrarenal abdominal aortic aneurysms: a survey of current practice by vascular surgeons in New South Wales and Australian Capital Territory.

BACKGROUND: The reported mortality rate following open elective repair of abdominal aortic aneurysm (AAA) varies between 0 and 12%. Much of the mortality and major morbidity is caused by cardiac events. The evidence regarding best practice for cardiac assessment and optimization of this patient group is unclear. The aim of the present study was to evaluate current practice of cardiac risk factor assessment by vascular surgeons in New South Wales (NSW) and Australian Capital Territory (ACT) for patients undergoing open elective repair of infrarenal AAA. METHODS: A postal questionnaire was sent to 46 surgeons in NSW and ACT identified as expressing a principal or major interest in vascular surgery. If no response was received within 3 weeks, a second questionnaire was sent and if no response was received after the second mailing, a telephone survey of non-responders was conducted. Data were collated regarding the importance of risk factors elicited by clinical history, preoperative investigation, referral for cardiological opinion, use of perioperative beta-blockade and the timing of aortic surgery in relation to coronary artery revascularization and acute myocardial infarction. RESULTS: The overall response rate was 87% (40/46) and the median (range) response time was 14 (4-109) days. Only 22 of 40 and 23 of 40 surgeons consider diabetes mellitus or renal impairment, respectively, to be important when assessing cardiac risk and 34 of 40 surgeons do not employ a validated risk index in preoperative assessment. Sixteen of 40 surgeons refer all patients needing AAA repair to a cardiologist, while 24 of 40 would initiate cardiac investigations themselves (either stress electrocardiography, scintigraphy or echocardiography). Seventeen surgeons always or usually commenced perioperative beta-blockade with wide variations in the commencement (1 to > 28 days preoperatively) and duration (< 1 week to > 28 days postoperatively) of treatment. The timing of AAA repair following coronary revascularization ranged from < 1 week to 6 months and delay in surgical repair of AAA following myocardial infarction ranged from < 1 week to > 6 months. CONCLUSION: Preoperative assessment of cardiac risk in patients for repair of AAA lacks consensus among vascular surgeons in NSW and ACT. The diversity of clinical practice may rest with the paucity of prospective trials published in the medical literature or the influence of local institutional facilities.

Aortic Aneurysm, Abdominal↗
PubMed1990

Surgeons' knowledge, attitude, and use of preoperative autologous blood donation.

Before a comprehensive educational program on preoperative autologous blood donation was begun, 118 surgeons from three different areas of the country were tested to assess their baseline knowledge and attitude about this practice. Test results were correlated with the percentage of eligible patients that the surgeons actually referred for preoperative donation during a period of observation. The purpose of this preliminary effort was to identify areas in the educational program that required emphasis. Overall, the surgeons' attitude toward preoperative donation was quite favorable, but their depth of knowledge varied. Misunderstandings may have led to diminished use of this service (eg, about 50% didn't realize that many patients with medical conditions or low hematocrits are permitted to donate). However, it is not clear that simply bolstering surgeons' knowledge will increase their appropriate use of preoperative donation. When all 118 surgeons were studied, their knowledge and attitude were unrelated to the percentage of eligible patients referred. However, when 44 surgeons who managed the largest number of eligible patients were analyzed separately, their use of preoperative donation was directly correlated with their knowledge and attitude. The local awareness of AIDS also significantly influenced the use of this service. It is proposed that knowledge of preoperative donation may be important for inducing surgeons to begin referring patients for this service. Once a pattern of successful participation is established, referral seems to increase with the acquisition of working knowledge.

Blood Transfusion, Autologous↗
PubMed2001

The use of ultrasound by breast surgeons in outpatients: an accurate extension of clinical diagnosis.

AIMS: To assess the accuracy of breast ultrasound scan (USS) performed by a surgeon in outpatients and to evaluate the additional contribution of USS to clinical diagnosis. METHODS: A prospective study of 302 patients with symptomatic breast disease (322 lumps) was performed. Group 1 consisted of 213 clinic USS of lumps surgically removed for appropriate clinical indications. In Group 2, a USS was performed on 231 lumps by both the surgeon and radiologists as part of triple assessment. Each clinic USS was compared to the surgical pathology (Group 1) or USS performed by the radiologist (Group 2). RESULTS: In Group 1 (n=213), 89 lumps were proven benign and 124 malignant on histology. Ultrasound scans performed by the surgeon compared to histology had a sensitivity of 98.3% and specificity of 91.7%. An abnormal clinic USS heightened the index of suspicion in 22/213 (10.3%) of cases felt clinically to be benign but subsequently confirmed malignant on histology. Fifty-seven lumps felt to be indeterminate clinically were correctly identified on USS by surgeon as benign (n=56) or malignant (n=1). In Group 2 (n=231), there was complete concordance of USS scans by surgeon and radiologists in 197 (96%) and complete discordance in eight (3.9%) patients. Of the discordant scans, the surgeon correctly identified 7/8 diagnoses on histology. A USS examination by the radiologists provided a correct diagnosis of 6/14 scans scored by the clinician as indeterminate. CONCLUSION: USS performed in outpatients by a breast surgeon is accurate and a useful adjunct to clinical assessment. This enables rapid diagnosis in one-stop breast clinics, selecting difficult diagnostic procedures for USS by radiologists at the same visit.

Adult↗
PubMed2000

Assessing adolescents and young girls for plastic surgical intervention: pre-surgical appearance ratings and appearance-related burdens as reported by adolescents and young adults, parents and surgeons.

Currently available research on psychological aspects of plastic surgery offers little basis for clinical decision making in the plastic surgeon's assessment of adolescents and young adults applying for surgery. Therefore, the research aims were to study: first, how these adolescents and young adults estimate their appearance as compared to their parents and plastic surgeons to determine the reality of their own appearance perception; second, what appearance-related burdens they experience to determine the urgency of their request for surgery; and third, the surgeons' considerations for the operation. Data were obtained from 184 plastic surgical patients aged 12-22 years (71.2% girls), 172 of their parents and 37 surgeons from 16 hospitals in The Netherlands, using appearance rating scales and to surgeons and parents, and reported substantial appearance-related suffering. There was a moderate to large overlap between the adolescent- and parent-reported burdens. In their assessment, surgeons took psychological and social impediments into consideration. In conclusion, plastic surgeons may rightfully assume that adolescents and young adults have a realistic view of their appearance and that they suffer from significant appearance-related burdens. Parents prove to be an important additional source of information.

Adolescent↗
PubMed2002

Do women newly diagnosed with breast cancer and consulting surgeon assess decision-making equally?

This study assesses the perception of the decision-making process of 25 surgeons and 194 patients (aged 21-81 years) who had newly diagnosed breast cancer and had to undergo mastectomy or breast-conserving surgery (BCS). The majority of women wanted to participate in decision-making. When it was medically possible to give a choice between BCS and mastectomy, only 59% of women received a choice. The main reason that 11% of the women went against surgeon's recommendations was fear of cancer recurrence. The most influential factors for women were the surgeon's recommendation, and fear of cancer recurrence. Medical assessment and the cosmetic result were the most influential factors for the surgeons. Female surgeons were more influenced by their assessment of the women's need for security, than male. In conclusion, not all women who are eligible for BCS receive an option. Women and surgeons emphasize influencing factors differently. The surgeon's gender was found to influence recommendation given.

Journal Article↗
PubMed2001

Surgeon-performed ultrasound imaging in acute surgical disorders.

As the role of the general surgeon continues to evolve, the surgeon's use of ultrasound imaging will surely influence practice patterns, particularly for the evaluation of patients in the acute setting. With the use of real-time imaging, the surgeon receives "instantaneous" information to augment the physical examination, to narrow the differential diagnosis, or to initiate an intervention. With select ultrasound examinations, the surgeon can rapidly evaluate adult and pediatric patients with an acute abdomen, especially those patients who are hypotensive. In the hands of the surgeon, this noninvasive, bedside tool can assess more accurately the presence, depth, and extent of an abscess, confirm complete aspiration, or diagnose wound dehiscence before it is apparent on physical examination. Ultrasound imaging is so accurate for the diagnosis of pyloric stenosis that it has essentially replaced the upper gastrointestinal series in most institutions. The surgeon's use of ultrasound imaging to detect a pleural effusion has virtually supplanted the lateral decubitus radiograph. Furthermore, an ultrasound-guided thoracentesis not only facilitates the procedure but improves its safety. As surgeons become more facile with ultrasound imaging, it is anticipated that other uses will develop to further enhance its value for the assessment of patients in the acute setting.

Abdomen, Acute↗